The They Can Get Help Falacy

In the health care debate there are those who argue that it is not necessary as people can already get medical treatment by visiting an ER as hospitals cannot deny them. This perception is both partly true and false. It is true that hospital ER rooms cannot deny a person who has a life threatening condition. They are required to offer treatment but only to the point where the person is no longer in the life threatening condition. Hence, a woman can receive care when she is starting to deliver her baby, but she cannot receive any treatment before that moment, and if the baby is born and mother and child well, they are quickly released.

Is the service that the hospital provides really free? No. The hospital will still go after the patient for the cost of the bare minimum to stabilize them. They will be billed and if the bills go unpaid and there are assets to which a lean can be attached, a lean is attached. If the person has a job, their salary will be garnered. The collections process adds costs and overhead to the hospital. What remains uncollected is still recovered by the hospital. The hospital does provide medical charity. It is a profit making venture and its losses are charged off in the fees charged to other patients.

For those who lack health insurance there is a double whammy, they get charged a higher rate for that which they cannot afford. We have several bills from my wife’s recent annual check-up. Each of the half-dozen items are discounted from 35 to 50% off which the insurance plan pays 80% leaving us with the remaining 20%. For example the one item that was billed at $323 was discounted to $170 with the plan paying $136 leaving us to pay $34. If we did not have medical insurance there would be no discount and would owe $323. Hence, those cannot afford medical insurance, or are denied coverage due to a pre-existing condition, or who have changed jobs and have yet to get beyond the 90 day, or 120 day or 180 day wait period, for that which they cannot afford in the first place are charged a much higher rate.

By the way, if she used a provider not approved by the plan (less than a third of the doctors in our area are approved) then the discount would be far less and our portion would be 30 or 40% depending on the nature of the item.

An Insidious Selfish Nature of a Complaint About Health Reform

Circulating amongst some critics of health care reform is that the health care system cannot handle all the extra new people who would come into the system. They state there are no provisions for increasing hospital capacity or the number doctors. Hence, there will be longer waiting times to see a doctor or get treatment in a hospital so health care should resisted.

In my August 7 blog was the first time I noted this criticism. While I touched upon it then, due to its insidious selfish nature it is worth visiting again. While expressed in various frameworks, the argument is essentially, if you are not already insured I do not want you in the system as I will have to wait a little longer to see my doctor and wait longer in an emergency room or get a bed in a hospital. While people using this argument may be good and well intentioned, I suspect that most are using this uncritically and without any thought as to its self-centered natured, that they would rather someone else not get medical care because they do not want to wait. What I have found most disappointing is that this thinking is circulating within the evangelistic community, the very community the speaks with pride about the value of sacrificing self for others, and the importance that we love and care for those in need.

As for hospital capacity, let us not forget the hospitals are private corporations that are expected by their shareholders to make at least a 20% profit annually (see my Sept 10 post). The firms that run hospitals are some of the most profitable firms on Wall Street. Like any corporation, their mission is to make as much money as possible by charging as much as they can while keeping their expenses as low as possible. As there is such competition between hospitals, they are driven to have the latest and largest machines possible, to provide décor and frills for staff, patients and visitors that are designed to make people feel more positive about the hospital in question so that they will give them their business.

If hospitals feel that they can make more money by expanding, they will do so. If expanding services does not add to their bottom line, they will not expand. As hospitals are a for profit identities, the government should not fund their expansion so that they can increase their profits. Government should only fund hospital construction when there is a clear benefit to the citizens, such as in attracting a hospital into a low income or rural community, or that there will be some control on fees charged.

As for the number of doctors, whereas in other industrialized countries governments are heavily invested in paying the majority of the costs of medical training, this does happen in the United States. Whereas in other countries the government helps to regulated how many individuals may be accepted into medical schools, in the United States this does not happen. Each medical program sets its own enrollment levels which are balanced between the demand-supply formula, attrition and the costs of producing a medical practitioner. While medical schools may get some funding from government grants, the bulk of a medical school’s funding comes from tuition and donations from the public, corporations and private foundations. A student receiving grants/forgivable loans to work in underserved communities is another matter. Ultimately, if there is a demand for more doctors, nurses and other medical personnel, and if the schools can raise the funds, and if there are sufficient qualified applicants, they will produce more medical personnel.

The United States unlike Canada and many other developed countries produces far more specialists that general practitioners. In Canada, France, Scandinavia, Germany, Great Britain, Italy a as well as in many other industrialized countries, more doctors are GPs than specialists. In these countries governments are involved in funding medical education at a much high level than is the United States. These countries allow only so many specialists to emerge from their medical schools for they place their focus upon preventive care and catching problems at an early stage. Within a financially driven system as exists in the United States the medical schools produces more specialists than GPs since specialists have greater earning potential than do GPs. In Canada I often could get into see my GP for a non-pressing matter in less than half the time it takes for me to see my GP in Iowa City or in Fairfax.

Health Care Reform and Rationing of Medical Care

Another red herring attack against health care reform is that it will lead to rationed medical treatment. Still another issue is that the reform will put the government between me and my doctor. As these are two sides of the same coin I will deal with them at the same time.

If you consult your medical coverage manual to check if a procedure is covered, you are already under the umbrella of a rationed system. If you have a list of doctors who you can visit under the plan at the full deductable and that list does not cover almost every doctor in the community, you are under already living under a rationed system. If you have to contact your provider for approval of particular procedures before receiving treatment or visiting the specialist, then you are living under a rationed health care system. If there are annual and/or life-time treatment limits in your medical plan (most plans have such a feature), you are living under a rationed system.

All but the most luxurious plans are rationed health care. The plans control which doctors I can visit with the plan covering the fees and what treatment they will cover. When my health care provider requires pre-approval, denies a service and mandates an alternate treatment be explored first a health care bureaucrat, most of whom have no medical training, has come between me and my doctor. Since living in the United States I have had more health care bureaucrats involved in medical decisions than I ever experienced under the Canadian system.

Annually my employer tweaks the medical plan in an effort to control costs. A shifting plan is a reality of the American system. Americans live under one of the most rationed health care systems in the world. The problem is that the average American is totally powerless to impact their design and shape of their health care plan. The decisions are made by the employer and the medical insurance provider as to what will or will not be covered. I could purchase off-system packages, but they are costly and full of loop-holes many of which only become apparent when I need treatment.

The average American would be surprised by the freedom and the quality of care they would experience under the German system, or the Swiss system, or the Italian, or the Japanese or the Canadian systems, all of which have been rated as having a superior system for the average system and at a less cost. In none of those countries are the range and extent of the American pre-approval processes does not exist. In those countries the plan outlines what is covered and what will not be covered, and that list is often more extensive that most American plans.

Then why would Americans strongly defend their existing system while turning a blind eye to the shortcomings of their own system? One reason is the American exceptionalist mindset. Americans, both leaders and the masses, believe that in most areas they have a superior systems and that while the world can learn from them, they have little to learn from others. American pride holds that America is the best in all areas, only grudgingly concede they are not the best in an area only when the volume of data indicates that their “best” position is no longer defensible on that matter.

In 1994 Taiwan decided to overhaul its medical system. Taiwan is a country that looks to copy the United States as much as possible. The Taiwanese initially looked at the American system and started to consult ex-patriots and second generation Taiwanese-Americans who were involved in the American system. The Taiwanese government heard over and over again, do not copy the American system as it is inferior to any other health care system existing in the developed world.